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Language-Specific Dysgraphia in Korean Stroke Patients

Yoon, Ji Hye MS*,†; Suh, Mee Kyung MS*,†; Kim, HyangHee PhD*,‡

Cognitive and Behavioral Neurology: December 2010 - Volume 23 - Issue 4 - p 247–255
doi: 10.1097/WNN.0b013e3181c2955e
Original Studies

Objectives We investigated how changes in the writing of 14 Korean stroke patients reflect the unique features of the Korean writing system.

Background The Korean writing system, Han-geul, has both linguistic and visuospatial/constructive characteristics. In the visuospatial construction of a syllable, the component consonant(s) and vowel(s) must be arranged from top-to-bottom and/or left-to-right within the form of a square. This syllabic organization, unique to Korean writing, may distinguish dysgraphia in Korean patients from the disorder in other languages, and reveal the effects of stroke on visuospatial/constructive abilities.

Methods We compared 2 groups of patients affected by stroke, 1 group with left hemisphere (LH) lesions and the other with right hemisphere (RH) lesions. We instructed them to write from a dictation of 90 monosyllabic stimuli, each presented with a real word cue. Patients had to repeat a target syllable and a word cue, and then to write the target syllable only.

Results Patients with LH and RH lesions produced qualitatively different error patterns. While the LH lesion group produced primarily linguistic errors, visuospatial/constructive errors predominated in the group with RH lesions. With regard to language-specific features, these Korean patients with RH lesions produced diverse visuospatial/constructive errors not commonly observed in dysgraphia of the English language.

Conclusions Language-specific writing errors by Korean stroke patients reflect the unique characteristics of Korean writing, which include the arrangement of strokes and graphemes within a square syllabic form by dimensional and spatial rules. These findings support the notion that the Korean writing system possesses a language-specific nature with both linguistic and visuospatial/constructive processes. Distinctive patterns of dysgraphia in the Korean language also suggest interactivity between linguistic and visuospatial/constructive levels of processing. This study is noteworthy for its systematic description of Korean dysgraphia in the largest group of patients studied to date.

*Graduate Program in Speech and Language Pathology, Yonsei University

Department of Neurology, Samsung Medical Center

Department of Rehabilitation Medicine and Rehabilitation Research Center, Yonsei University College of Medicine, Seoul, Korea

Reprints: HyangHee Kim, PhD, CCC-SLP, BC-ANCDS, Graduate Program in Speech and Language, Rehabilitation Hospital, Yonsei University College of Medicine, 250 Sungsan-ro, Seodaemun-gu, Seoul 120-752, Korea (e-mail:

Presented parts of this study at the 2006 American Speech-Language-Hearing Association (ASHA) Convention held in Miami, FL.

Received December 18, 2008

Accepted September 20, 2009

© 2010 Lippincott Williams & Wilkins, Inc.